Our centre
Patient Care Service
Data Protection Rights Request Form (includes request for clinical documentation)

Data Protection Rights Request Form (includes request for clinical documentation)

You can download the form here. Tick the access right box to request clinical documentation.

Send your duly accredited request form by e-mail to: Info.tkn@quironsalud.es This link opens in a popup window

Accreditation required to collect clinical documentation

The patient

Original ID card or passport

Person authorised by the patient

Fill in the section on this form or provide a letter of authorisation or representation signed by the patient, including the full name of the authorised person and their relationship to the patient
Original ID card or passport of the patient Attach a photocopy to the request form
Original ID card or passport of the authorised person Attach a photocopy to the request form

Deceased

Original ID card or passport of the deceased Attach a photocopy to the request form
Original ID card or passport of the applicant. Attach a photocopy to the request form
Documentation accrediting the family relationship. Attach a photocopy to the request form
Death certificate (if death did not occur at our centre)

Legal guardian of the patient

Document certifying the court appointment of the guardian
Original ID card or passport of the guardian. Attach a photocopy to the request form
Original ID card or passport of the ward. Attach a photocopy to the request form

Parent (for minors under 16 years of age)

Original ID card or passport of the applicant. Attach a photocopy to the request form
Family booklet Attach a photocopy to the request form